MHTPS_HCPCS_NDC_021014 Updated as of 1/30/141
39447TX0314
Procedure Code HCPCS Description
90283 IMMUNE GLOBULIN (IGIV), HUMAN, FOR INTRAVENOUS USE
90284 IMMUNE GLOBULIN (SCIG), HUMAN, FOR USE IN SUBCUTANEOUS INFUSIONS, 100 MG, EACH
90291 CYTOMEGALOVIRUS IMMUNE GLOBULIN (CMV-IGIV), HUMAN, FOR INTRAVENOUS USE
90371 HEPATITIS B IMMUNE GLOBULIN (HBIG), HUMAN, FOR INTRAMUSCULAR USE
90375 RABIES IMMUNE GLOBULIN (RIG), HUMAN, FOR INTRAMUSCULAR AND/ OR SUBCUTANEOUS USE
C9133 Factor ix (antihemophilic factor, recombinant), rixibus, per i.u.
C9250 HUMAN PLASMA FIBRIN SEALANT, VAPOR-HEATED, SOLVENT-DETERGENT (ARTISS), 2ML
C9254 INJECTION, LACOSAMIDE, 1 MG
C9257 INJECTION, BEVACIZUMAB, 0.25 MG
C9275 INJECTION, HEXAMINOLEVULINATE HYDROCHLORIDE, 100 MG, PER STUDY DOSE
C9399 UNCLASSIFIED DRUGS OR BIOLOGICALS
G9018ZANAMIVIR, INHALATION POWDER ADMINISTERED THROUGH INHALER, PER 10 MG (FOR USE AS A MEDICARE APPROVED DEMONSTRATION PROJECT)
G9019OSELTAMIVIR PHOSPHATE, ORAL, PER 75 MG (FOR USE AS A MEDICARE APPROVED DEMONSTRATION PROJECT)
J0120 TETRACYCLIN INJECTION
J0129 ABATACEPT INJECTION
J0130 ABCIXIMAB INJECTION
J0131 ACETAMINOPHEN INJECTION
J0132 ACETYLCYSTEINE INJECTION
J0133 ACYCLOVIR INJECTION
J0135 ADALIMUMAB INJECTION
J0150 INJECTION ADENOSINE 6 MG
MHTPS_HCPCS_NDC_021014 Updated as of 1/30/142
Procedure Code HCPCS Description
J0151Injection, adenosine for diagnostic use, 1 mg (not to be used to report any adenosine phosphate compounds, instead use a9270)
J0152INJECTION, ADENOSINE FOR DIAGNOSTIC USE, 30 MG (NOT TO BE USED TO REPORT ANY ADENOSINE PHOSPHATE
J0171 ADRENALIN EPINEPHRINE INJECT
J0178 AFLIBERCEPT INJECTION
J0180 INJECTION, ADRENOSEM SALICYLATE UP TO 10 MG
J0190 INJ BIPERIDEN LACTATE/5 MG
J0205 ALGLUCERASE INJECTION
J0210 METHYLDOPATE HCL INJECTION
J0215 ALEFACEPT
J0220 INJECTION, ALLERGY DESENSITIZATION, AQUEOUS PREPARATION
J0256 ALPHA 1 PROTEINASE INHIBITOR
J0257 GLASSIA INJECTION
J0278 AMIKACIN SULFATE INJECTION
J0280 AMINOPHYLLIN 250 MG INJ
J0282 AMIODARONE HCL
J0285 AMPHOTERICIN B
J0287 AMPHOTERICIN B LIPID COMPLEX
J0288 AMPHO B CHOLESTERYL SULFATE
J0289 AMPHOTERICIN B LIPOSOME INJ
J0290 AMPICILLIN 500 MG INJ
J0295 AMPICILLIN SODIUM PER 1.5 GM
J0300 AMOBARBITAL 125 MG INJ
J0330 SUCCINYCHOLINE CHLORIDE INJ
MHTPS_HCPCS_NDC_021014 Updated as of 1/30/143
Procedure Code HCPCS Description
J0348 ANADULAFUNGIN INJECTION
J0360 HYDRALAZINE HCL INJECTION
J0364 APOMORPHINE HYDROCHLORIDE
J0380 INJ METARAMINOL BITARTRATE
J0390 CHLOROQUINE INJECTION
J0395 ARBUTAMINE HCL INJECTION
J0400 INJ TRIMETHAPHAN CAMSYLATE
J0401 Injection, aripiprazole, extended release, 1 mg
J0456 AZITHROMYCIN
J0461 ATROPINE SULFATE INJECTION
J0470 DIMECAPROL INJECTION
J0475 BACLOFEN 10 MG INJECTION
J0476 BACLOFEN INTRATHECAL TRIAL
J0480 INJECTION, BELLAFOLINE, UP TO 0.5 MG
J0485 BELATACEPT INJECTION
J0490 INJECTION, BENADRYL HCL, UP TO 50 MG
J0500 DICYCLOMINE INJECTION
J0515 INJ BENZTROPINE MESYLATE
J0520 BETHANECHOL CHLORIDE INJECT
J0558 PENG BENZATHINE/PROCAINE INJ
J0561 PENICILLIN G BENZATHINE INJ
J0583 BIVALIRUDIN
J0586 ABOBOTULINUMTOXINA
MHTPS_HCPCS_NDC_021014 Updated as of 1/30/144
Procedure Code HCPCS Description
J0587 BOTULINUM TOXIN TYPE B
J0588 INCOBOTULINUMTOXIN A
J0592 BUPRENORPHINE HYDROCHLORIDE
J0594 BUSULFAN INJECTION
J0595 BUTORPHANOL TARTRATE 1 MG
J0598 C1 ESTERASE INHIBITOR INJ
J0600 EDETATE CALCIUM DISODIUM INJ
J0610 CALCIUM GLUCONATE INJECTION
J0620 CALCIUM GLYCER & LACT/10 ML
J0630 CALCITONIN SALMON INJECTION
J0636 INJ CALCITRIOL PER 0.1 MCG
J0637 CASPOFUNGIN ACETATE
J0638 CANAKINUMAB INJECTION
J0641 INJECTION, LEVOLEUCOVORIN CALCIUM, 0.5 MG
J0670 INJ MEPIVACAINE HCL/10 ML
J0690 CEFAZOLIN SODIUM INJECTION
J0692 CEFEPIME HCL FOR INJECTION
J0694 CEFOXITIN SODIUM INJECTION
J0697 STERILE CEFUROXIME INJECTION
J0698 CEFOTAXIME SODIUM INJECTION
J0702 BETAMETHASONE ACET&SOD PHOSP
J0706 CAFFEINE CITRATE INJECTION
J0710 CEPHAPIRIN SODIUM INJECTION
MHTPS_HCPCS_NDC_021014 Updated as of 1/30/145
Procedure Code HCPCS Description
J0713 INJ CEFTAZIDIME PER 500 MG
J0715 CEFTIZOXIME SODIUM / 500 MG
J0716 CENTRUROIDES IMMUNE F(AB)
J0717 Injection, certolizumab pegol, 1 mg
J0718 CERTOLIZUMAB PEGOL INJ
J0720 CHLORAMPHENICOL SODIUM INJEC
J0725 CHORIONIC GONADOTROPIN/1000U
J0735 CLONIDINE HYDROCHLORIDE
J0740 CIDOFOVIR INJECTION
J0743 CILASTATIN SODIUM INJECTION
J0744 CIPROFLOXACIN IV
J0760 COLCHICINE INJECTION
J0770 COLISTIMETHATE SODIUM INJ
J0775 COLLAGENASE, CLOST HIST INJ
J0780 PROCHLORPERAZINE INJECTION
J0795 CORTICORELIN OVINE TRIFLUTAL
J0800 CORTICOTROPIN INJECTION
J0833 COSYNTROPIN INJECTION NOS
J0834 COSYNTROPIN CORTROSYN INJ
J0840 Injection, Crotalidae Polyvalent Immune Fab
J0850 CYTOMEGALOVIRUS IMM IV /VIAL
J0878 DAPTOMYCIN INJECTION
J0882 DARBEPOETIN ALFA, ESRD USE
MHTPS_HCPCS_NDC_021014 Updated as of 1/30/146
Procedure Code HCPCS Description
J0895 DEFEROXAMINE MESYLATE INJ
J0897 DENOSUMAB INJECTION
J0945 BROMPHENIRAMINE MALEATE INJ
J1000 DEPO-ESTRADIOL CYPIONATE INJ
J1020 METHYLPREDNISOLONE 20 MG INJ
J1030 METHYLPREDNISOLONE 40 MG INJ
J1060 TESTOSTERONE CYPIONATE 1 ML
J1070 TESTOSTERONE CYPIONAT 100 MG
J1080 TESTOSTERONE CYPIONAT 200 MG
J1094 INJ DEXAMETHASONE ACETATE
J1110 INJ DIHYDROERGOTAMINE MESYLT
J1120 ACETAZOLAMID SODIUM INJECTIO
J1160 DIGOXIN INJECTION
J1162 DIGOXIN IMMUNE FAB (OVINE)
J1165 PHENYTOIN SODIUM INJECTION
J1190 DEXRAZOXANE HCL INJECTION
J1200 DIPHENHYDRAMINE HCL INJECTIO
J1205 CHLOROTHIAZIDE SODIUM INJ
J1212 DIMETHYL SULFOXIDE 50% 50 ML
J1230 METHADONE INJECTION
J1240 DIMENHYDRINATE INJECTION
J1245 DIPYRIDAMOLE INJECTION
J1250 INJ DOBUTAMINE HCL/250 MG
MHTPS_HCPCS_NDC_021014 Updated as of 1/30/147
Procedure Code HCPCS Description
J1265 DOPAMINE INJECTION
J1267 DORIPENEM INJECTION
J1270 INJECTION, DOXERCALCIFEROL, 1 MCG
J1300 INJECTION, DURATRAD, UP TO 10 MG
J1324 ENFUVIRTIDE INJECTION
J1325 EPOPROSTENOL INJECTION
J1327 EPTIFIBATIDE INJECTION
J1330 ERGONOVINE MALEATE INJECTION
J1335 ERTAPENEM INJECTION
J1364 ERYTHRO LACTOBIONATE /500 MG
J1380 ESTRADIOL VALERATE 10 MG INJ
J1410 INJ ESTROGEN CONJUGATE 25 MG
J1430 INJECTION, ESTATE, UP TO 10 MG
J1435 INJECTION ESTRONE PER 1 MG
J1436 ETIDRONATE DISODIUM INJ
J1438 ETANERCEPT INJECTION
J1440 Injection, Filgrastim (G-Csf), 300 Mcg
J1441 INJECTION, FILGRASTIM (G-CSF), 480 MCG
J1442 Injection, filgrastim (g-csf), 1 microgram
J1450 FLUCONAZOLE
J1451 FOMEPIZOLE, 15 MG
J1453 INJECTION, FOSAPREPITANT, 1 MG
J1455 FOSCARNET SODIUM INJECTION
MHTPS_HCPCS_NDC_021014 Updated as of 1/30/148
Procedure Code HCPCS Description
J1457 GALLIUM NITRATE INJECTION
J1458 GALSULFASE INJECTION
J1459 Inj IVIG privigen 500 mg
J1460 GAMMA GLOBULIN 1 CC INJ
J1556 Injection, immune globulin (bivigam), 500 mg
J1557 GAMMAPLEX INJECTION
J1559 HIZENTRA INJECTION
J1560 GAMMA GLOBULIN > 10 CC INJ
J1568 OCTAGAM INJECTION
J1569 GAMMAGARD LIQUID INJECTION
J1570 GANCICLOVIR SODIUM INJECTION
J1571 HEPAGAM B IM INJECTION
J1572 FLEBOGAMMA INJECTION
J1573 HEPAGAM B INTRAVENOUS, INJ
J1580 GARAMYCIN GENTAMICIN INJ
J1590 INJECTION, GATIFLOXACIN, 10 MG
J1595 INJECTION GLATIRAMER ACETATE
J1599 IVIG NON-LYOPHILIZED, NOS
J1600 GOLD SODIUM THIOMALEATE INJ
J1602 Injection, golimumab, 1 mg, for intravenous use
J1610 GLUCAGON HYDROCHLORIDE/1 MG
J1620 GONADORELIN HYDROCH/ 100 MCG
J1630 HALOPERIDOL INJECTION
MHTPS_HCPCS_NDC_021014 Updated as of 1/30/149
Procedure Code HCPCS Description
J1640 INJECTION, HEPARIN SODIUM, 30 ML
J1642 INJ HEPARIN SODIUM PER 10 U
J1644 INJ HEPARIN SODIUM PER 1000U
J1645 DALTEPARIN SODIUM
J1650 INJ ENOXAPARIN SODIUM
J1652 FONDAPARINUX SODIUM
J1655 TINZAPARIN SODIUM INJECTION
J1670 TETANUS IMMUNE GLOBULIN INJ
J1700 HYDROCORTISONE ACETATE INJ
J1710 HYDROCORTISONE SODIUM PH INJ
J1720 HYDROCORTISONE SODIUM SUCC I
J1725 HYDROXYPROGESTERONE CAPROATE
J1730 DIAZOXIDE INJECTION
J1740 INJECTION, HYDROXYPROGESTERONE CAPROATE, DELALUTIN, UP TO 250MG
J1741 HYDROXYPROGESTERONE CAP 250
J1742 IBUTILIDE FUMARATE INJECTION
J1743 IDURSULFASE INJECTION
J1750 IRON DEXTRAN
J1756 IRON SUCROSE INJECTION
J1786 IMUGLUCERASE INJECTION
J1790 DROPERIDOL INJECTION
J1800 PROPRANOLOL INJECTION
J1826 INTERFERON BETA-1A INJ
MHTPS_HCPCS_NDC_021014 Updated as of 1/30/1410
Procedure Code HCPCS Description
J1830 INTERFERON BETA-1B / .25 MG
J1840 KANAMYCIN SULFATE 500 MG INJ
J1850 KANAMYCIN SULFATE 75 MG INJ
J1890 CEPHALOTHIN SODIUM INJECTION
J1930 Injection, Lanreotide, 1 MG
J1931 LARONIDASE INJECTION
J1940 FUROSEMIDE INJECTION
J1945 LEPIRUDIN
J1950 LEUPROLIDE ACETATE /3.75 MG
J1953 Injection, Levetiracetam, 10 MG
J1955 INJ LEVOCARNITINE PER 1 GM
J1956 LEVOFLOXACIN INJECTION
J1960 LEVORPHANOL TARTRATE INJ
J1980 HYOSCYAMINE SULFATE INJ
J1990 CHLORDIAZEPOXIDE INJECTION
J2010 LINCOMYCIN INJECTION
J2020 INJECTION, LINEZOLID, 200 MG
J2060 LORAZEPAM INJECTION
J2150 MANNITOL INJECTION
J2175 MEPERIDINE HYDROCHL /100 MG
J2180 MEPERIDINE/PROMETHAZINE INJ
J2185 MEROPENEM
J2210 METHYLERGONOVIN MALEATE INJ
MHTPS_HCPCS_NDC_021014 Updated as of 1/30/1411
Procedure Code HCPCS Description
J2248 MICAFUNGIN SODIUM INJECTION
J2250 INJ MIDAZOLAM HYDROCHLORIDE
J2260 INJ MILRINONE LACTATE / 5 ML
J2270 MORPHINE SULFATE INJECTION
J2271 MORPHINE SO4 INJECTION 100MG
J2275 MORPHINE SULFATE INJECTION
J2278 ZICONOTIDE INJECTION
J2280 INJ, MOXIFLOXACIN 100 MG
J2300 INJ NALBUPHINE HYDROCHLORIDE
J2310 INJ NALOXONE HYDROCHLORIDE
J2315 NALTREXONE, DEPOT FORM
J2320 NANDROLONE DECANOATE 50 MG
J2323 NATALIZUMAB INJECTION
J2325 NESIRITIDE INJECTION
J2353 OCTREOTIDE INJECTION, DEPOT
J2354 OCTREOTIDE INJ, NON-DEPOT
J2355 OPRELVEKIN INJECTION
J2358 OLANZAPINE LONG-ACTING INJ
J2360 ORPHENADRINE INJECTION
J2370 PHENYLEPHRINE HCL INJECTION
J2400 CHLOROPROCAINE HCL INJECTION
J2410 OXYMORPHONE HCL INJECTION
J2425 PALIFERMIN INJECTION
MHTPS_HCPCS_NDC_021014 Updated as of 1/30/1412
Procedure Code HCPCS Description
J2426 PALIPERIDONE PALMITATE INJ
J2440 PAPAVERIN HCL INJECTION
J2460 OXYTETRACYCLINE INJECTION
J2501 PARICALCITOL
J2503 PEGAPTANIB SODIUM INJECTION
J2504 PEGADEMASE BOVINE, 25 IU
J2507 PEGLOTICASE INJECTION
J2510 PENICILLIN G PROCAINE INJ
J2515 PENTOBARBITAL SODIUM INJ
J2540 PENICILLIN G POTASSIUM INJ
J2543 PIPERACILLIN/TAZOBACTAM
J2545 PENTAMIDINE ISETHIONTE/300MG
J2560 PHENOBARBITAL SODIUM INJ
J2562 PLERIXAFOR INJECTION
J2590 OXYTOCIN INJECTION
J2597 INJ DESMOPRESSIN ACETATE
J2650 PREDNISOLONE ACETATE INJ
J2670 TOTAZOLINE HCL INJECTION
J2675 INJ PROGESTERONE PER 50 MG
J2680 FLUPHENAZINE DECANOATE 25 MG
J2690 PROCAINAMIDE HCL INJECTION
J2700 OXACILLIN SODIUM INJECITON
J2710 NEOSTIGMINE METHYLSLFTE INJ
MHTPS_HCPCS_NDC_021014 Updated as of 1/30/1413
Procedure Code HCPCS Description
J2720 INJ PROTAMINE SULFATE/10 MG
J2724 PROTEIN C CONCENTRATE
J2730 PRALIDOXIME CHLORIDE INJ
J2760 PHENTOLAINE MESYLATE INJ
J2765 METOCLOPRAMIDE HCL INJECTION
J2770 QUINUPRISTIN/DALFOPRISTIN
J2778 RANIBIZUMAB INJECTION
J2780 RANITIDINE HYDROCHLORIDE INJ
J2785 Injection, Regadenoson, 0.1 MG
J2788 RHO D IMMUNE GLOBULIN 50 MCG
J2790 RHO D IMMUNE GLOBULIN INJ
J2791 RHOPHYLAC INJECTION
J2792 RHO(D) IMMUNE GLOBULIN H, SD
J2793 RILONACEPT INJECTION
J2795 ROPIVACAINE HCL INJECTION
J2796 ROMIPLOSTIM INJECTION
J2800 METHOCARBAMOL INJECTION
J2805 SINCALIDE INJECTION
J2810 INJ THEOPHYLLINE PER 40 MG
J2850 INJECTION, SAVACORT-100, UP TO 100 MG
J2916 NA FERRIC GLUCONATE COMPLEX
J2920 METHYLPREDNISOLONE INJECTION
J2930 METHYLPREDNISOLONE INJECTION
MHTPS_HCPCS_NDC_021014 Updated as of 1/30/1414
Procedure Code HCPCS Description
J2941 SOMATROPIN INJECTION
J2950 PROMAZINE HCL INJECITON
J2993 RETEPLASE INJECTION
J2997 ALTEPLASE RECOMBINANT
J3000 STREPTOMYCIN INJECTION
J3030 SUMATRIPTAN SUCCINATE / 6 MG
J3060 Injection, taliglucerace alfa, 10 units
J3070 PENTAZOCINE HCL INJECITON
J3095 Injection, telavancin, 10 mg
J3101 Injection, Tenecteplase, 1 MG
J3105 TERBUTALINE SULFATE INJ
J3110 INJECTION, TESLAC, UP TO 100 MG
J3120 TESTOSTERONE ENANTHATE INJ
J3130 TESTOSTERONE ENANTHATE INJ
J3140 TESTOSTERONE SUSPENSION INJ
J3150 TESTOSTERON PROPIONATE INJ
J3230 CHLORPROMAZINE HCL INJECTION
J3240 THYROTROPIN INJECTION
J3243 TIGECYCLINE INJECTION
J3246 TIROFIBAN HCL
J3250 TRIMETHOBENZAMIDE HCL INJ
J3260 TOBRAMYCIN SULFATE INJECTION
J3262 TOCILIZUMAB INJECTION
MHTPS_HCPCS_NDC_021014 Updated as of 1/30/1415
Procedure Code HCPCS Description
J3265 INJECTION TORSEMIDE 10 MG/ML
J3280 THIETHYLPERAZINE MALEATE INJ
J3285 TREPROSTINIL INJECTION
J3300 Injection, Triamcinolone Acetonide, preservative free, 1 MG
J3301 TRIAMCINOLONE ACETONIDE INJ
J3302 TRIAMCINOLONE DIACETATE INJ
J3303 TRIAMCINOLONE HEXACETONL INJ
J3305 INJ TRIMETREXATE GLUCORONATE
J3310 PERPHENAZINE INJECITON
J3315 TRIPTORELIN PAMOATE
J3320 SPECTINOMYCN DI-HCL INJ
J3350 UREA INJECTION
J3357 USTEKINUMAB INJECTION
J3360 DIAZEPAM INJECTION
J3364 UROKINASE 5000 IU INJECTION
J3365 UROKINASE 250,000 IU INJ
J3385 VELAGLUCERASE ALFA
J3396 VERTEPORFIN INJECTION
J3400 TRIFLUPROMAZINE HCL INJ
J3410 HYDROXYZINE HCL INJECITON
J3411 THIAMINE HCL 100 MG
J3415 PYRIDOXINE HCL 100 MGG
J3420 VITAMIN B12 INJECTION
MHTPS_HCPCS_NDC_021014 Updated as of 1/30/1416
Procedure Code HCPCS Description
J3430 VITAMIN K PHYTONADIONE INJ
J3465 INJECTION, VORICONAZOLE
J3470 HYALURONIDASE INJECTION
J3471 OVINE, UP TO 999 USP UNITS
J3472 OVINE, 1000 USP UNITS
J3473 HYALURONIDASE RECOMBINANT
J3475 INJ MAGNESIUM SULFATE
J3480 INJ POTASSIUM CHLORIDE
J3485 ZIDOVUDINE
J3486 ZIPRASIDONE MESYLATE
J3488 RECLAST INJECTION
J3489 Injection, zoledronic acid, 1 mg
J3520 EDETATE DISODIUM PER 150 MG
J3535 METERED DOSE INHALER DRUG
J3590 UNCLASSIFIED BIOLOGICS
J7030 NORMAL SALINE SOLUTION INFUS
J7040 NORMAL SALINE SOLUTION INFUS
J7042 5% DEXTROSE/NORMAL SALINE
J7060 5% DEXTROSE/WATER
J7070 D5W INFUSION
J7120 RINGERS LACTATE INFUSION
J7191 FACTOR VIII (PORCINE)
J7196 OTHR HEMOPHILIA CLOT FACTORSNew description: INJECTION, ANTITHROMBIN RECOMBINANT, 50 I.U.
MHTPS_HCPCS_NDC_021014 Updated as of 1/30/1417
Procedure Code HCPCS Description
J7199 HEMOPHILIA CLOT FACTOR NOC
J7301 Levonorgestrel-releasing intrauterine contraceptive system (skyla), 13.5 mg
J7308 AMINOLEVULINIC ACID HCL TOP
J7311 FLUOCINOLONE ACETONIDE IMPLT
J7312 DEXAMETHASONE INTRA IMPLANT
J7316 Injection, ocriplasmin, 0.125 mg
J7321 HYALGAN/SUPARTZ INJ PER DOSE
J7323 EUFLEXXA INJ PER DOSE
J7324 ORTHOVISC INJ PER DOSE
J7325 SYNVISC OR SYNVISC-ONE
J7326 GEL-ONE
J7330 CULTURED CHONDROCYTES IMPLNT
J7335 CAPSAICIN 8% PATCH
J7501 AZATHIOPRINE PARENTERAL
J7504 LYMPHOCYTE IMMUNE GLOBULIN
J7505 MONOCLONAL ANTIBODIES
J7511 ANTITHYMOCYTE GLOBULN RABBIT
J7513 DACLIZUMAB, PARENTERAL
J7516 CYCLOSPORIN PARENTERAL 250MG
J7525 TACROLIMUS INJECTION
J7599 IMMUNOSUPPRESSIVE DRUG NOC
J7605 ARFORMOTEROL NON-COMP UNIT
J7608 ACETYLCYSTEINE INH SOL U D
MHTPS_HCPCS_NDC_021014 Updated as of 1/30/1418
Procedure Code HCPCS Description
J7611 ALBUTEROL NON-COMP CON
J7612 LEVALBUTEROL NON-COMP CON
J7613 ALBUTEROL NON-COMP UNIT
J7614 LEVALBUTEROL NON-COMP UNIT
J7620 ALBUTEROL SULFATE .083%/ML
J7622 BECLOMETHASOME INHALATN SOL
J7626 BUDESONIDE INHALATION SOL
J7631 CROMOLYN SODIUM INH SOL U D
J7633 BUDESONIDE CONCENTRATED SOL
J7639 DORNASE ALPHA INHAL SOL U D
J7665 ISOPROTERENOL HCL 1% INJ
J7674 METHACHOLINE CHLORIDE, NEB
J7682 TOBRAMYCIN INHALATION SOL
J7699 INHALATION SOLUTION FOR DME
J7799 NON-INHALATION DRUG FOR DME
J8999 ORAL PRESCRIPTION DRUG CHEMO
J9002 DOXIL INJECTION
J9010 DOXORUBICIN HCL, 50 MG VIAL
J9015 ALDESLEUKIN/SINGLE USE VIAL
J9017 ARSENIC TRIOXIDE
J9019 ERWINAZE INJECTION
J9020 ASPARAGINASE INJECTION
J9027 CLOFARABINE INJECTION
MHTPS_HCPCS_NDC_021014 Updated as of 1/30/1419
Procedure Code HCPCS Description
J9031 BCG LIVE INTRAVESICAL VAC
J9033 INJECTION, BENDAMUSTINE HCL, 1 MG
J9042 BRENTUXIMAB VEDOTIN INJ
J9043 CABAZITAXEL INJECTION
J9050 CARMUS BISCHL NITRO INJ
J9065 INJ CLADRIBINE PER 1 MG
J9070 CYCLOPHOSPHAMIDE 100 MG INJ
J9098 CYTARABINE LIPOSOME
J9100 CYTARABINE HCL 100 MG INJ
J9120 DACTINOMYCIN ACTINOMYCIN D
J9130 DACARBAZINE 10 MG INJ
J9150 DAUNORUBICIN
J9151 DAUNORUBICIN CITRATE LIPOSOM
J9155 DEGARELIX INJECTION
J9160 DENILEUKIN DIFTITOX, 300 MCG
J9165 DIETHYLSTILBESTROL INJECTION
J9171 DOCETAXEL INJECTION
J9175 ELLIOTTS B SOLUTION PER ML
J9179 ERIBULIN MESYLATE INJECTION
J9181 ETOPOSIDE 10 MG INJ
J9185 FLUDARABINE PHOSPHATE INJ
J9200 FLOXURIDINE INJECTION
J9202 GOSERELIN ACETATE IMPLANT
MHTPS_HCPCS_NDC_021014 Updated as of 1/30/1420
Procedure Code HCPCS Description
J9207 INJECTION, IXABEPILONE, 1 MG
J9208 IFOSFOMIDE INJECTION
J9209 MESNA INJECTION
J9211 IDARUBICIN HCL INJECITON
J9212 INTERFERON ALFACON-1
J9213 INTERFERON ALFA-2A INJ
J9214 INTERFERON ALFA-2B INJ
J9215 INTERFERON ALFA-N3 INJ
J9216 INTERFERON GAMMA 1-B INJ
J9218 LEUPROLIDE ACETATE INJECITON
J9219 LEUPROLIDE ACETATE IMPLANT
J9225 VANTAS IMPLANT
J9226 SUPPRELIN LA IMPLANT
J9228 IPILIMUMAB INJECTION
J9230 MECHLORETHAMINE HCL INJ
J9245 INJ MELPHALAN HYDROCHL 50 MG
J9250 METHOTREXATE SODIUM INJ
J9260 METHOTREXATE SODIUM INJ
J9261 NELARABINE INJECTION
J9262 Injection, omacetaxine mepesuccinate, 0.01 mg
J9266 PEGASPARGASE/SINGL DOSE VIAL
J9268 PENTOSTATIN INJECTION
J9280 MITOMYCIN 5 MG INJ
MHTPS_HCPCS_NDC_021014 Updated as of 1/30/1421
Procedure Code HCPCS Description
J9300 GEMTUZUMAB OZOGAMICIN, 5MG
J9302 OFATUMUMAB INJECTION
J9303 PANITUMUMAB INJECTION
J9306 Injection, pertuzumab, 1 mg
J9307 PRALATREXATE INJECTION
J9315 ROMIDEPSIN INJECTION
J9320 STREPTOZOCIN INJECTION
J9328 TEMOZOLOMIDE INJECTION
J9330 Injection, Temsirolimus, 1 MG
J9340 THIOTEPA INJECTION
J9351 TOPOTECAN INJECTION
J9357 VALRUBICIN, 200 MG
J9360 VINBLASTINE SULFATE INJ
J9370 VINCRISTINE SULFATE 1 MG INJ
J9371 Injection, vincristine sulfate liposome, 1 mg
J9395 INJECTION, FULVESTRANT
J9600 PORFIMER SODIUM
J9999 CHEMOTHERAPY DRUG
Q0138 FERUMOXYTOL, NON-ESRD
Q0139 FERUMOXYTOL, ESRD USE
Q0163 DIPHENHYDRAMINE HCL 50MG
Q0164 PROCHLORPERAZINE MALEATE 5MG
Q0165 PROCHLORPERAZINE MALEATE10MG
MHTPS_HCPCS_NDC_021014 Updated as of 1/30/1422
Procedure Code HCPCS Description
Q0166 GRANISETRON HCL 1 MG ORAL
Q0167 DRONABINOL 2.5MG ORAL
Q0168 DRONABINOL 5MG ORAL
Q0169 PROMETHAZINE HCL 12.5MG ORAL
Q0170 PROMETHAZINE HCL 25 MG ORAL
Q0171 CHLORPROMAZINE HCL 10MG ORAL
Q0172 CHLORPROMAZINE HCL 25MG ORAL
Q0173 TRIMETHOBENZAMIDE HCL 250MG
Q0175 PERPHENAZINE 4MG ORAL
Q0176 PERPHENAZINE 8MG ORAL
Q0177 HYDROXYZINE PAMOATE 25MG
Q0178 HYDROXYZINE PAMOATE 50MG
Q0180 DOLASETRON MESYLATE ORAL
Q0181 UNSPECIFIED ORAL ANTI-EMETIC
Q2004 BLADDER CALCULI IRRIG SOL
Q2009 FOSPHENYTOIN, 50 MG
Q2017 TENIPOSIDE, 50 MG
Q2026 RADIESSE INJECTION
Q2049 Sipuleucel-T, minimum of 50 million autologous cd54+ cells activated with PAP-GM-CSF, including
Q2050 INJECTION, DOXORUBICIN HYDROCHLORIDE, LIPOSOMAL, NOT OTHERWISE SPECIFIED, 10MG
Q2051 INJECTION, ZOLEDRONIC ACID, NOT OTHERWISE SPECIFIED, 1MG
Q3025 IM INJ INTERFERON BETA 1-A
Q3026 SUBC INJ INTERFERON BETA-1A
MHTPS_HCPCS_NDC_021014 Updated as of 1/30/1423
Procedure Code HCPCS Description
Q3027 Injection, interferon beta-1a, 1 mcg for intramuscular use
Q3028 Injection, interferon beta-1a, 1 mcg for subcutaneous use
Q4074 ILOPROST NON-COMP UNIT DOSE
Q4081 EPO ALFA 100 UNITS, ESRD
Q9956 INJ OCTAFLUOROPROPANE MIC,ML
Q9957 INJ PERFLUTREN LIP MICROS, ML
S0017 INJECTION, AMINOCAPROIC ACID
S0020 Bupivicaine, HCL, 30 ml
S0021 INJECTION, CEFTOPERAZONE SODIUM, 1 G
S0023 INJECTION, CIMETIDINE HCL, 300 MG
S0028 INJECTION, FAMOTIDINE, 20 MG
S0142 COLISTIMETHATE INH SOL MG
S0145 PEG INTERFERON ALFA-2A/180
S0148 PEG INTERFERON ALFA-2B/10
S0164 INJECTION PANTROPRAZOLE
S0166 INJ OLANZAPINE 2.5MG
S0189 TESTOSTERONE PELLET 75 MG
S4993 Contraceptive pills for birth control
S5010 5% DEXTROSE AND 0.45% SALINE
S5011 5% DEXTROSE IN LACTATED RING
S5550 INSULIN RAPID 5 U
S5551 INSULIN MOST RAPID 5 U
S5552 INSULIN INTERMED 5 U
MHTPS_HCPCS_NDC_021014 Updated as of 1/30/1424
Procedure Code HCPCS Description
S5553 INSULIN LONG ACTING 5 U
J0207 AMIFOSTINE
J0585 BOTULINUM TOXIN A PER UNIT
J0640 LEUCOVORIN CALCIUM INJECTION
J0696 CEFTRIAXONE SODIUM INJECTION
J0745 INJ CODEINE PHOSPHATE /30 MG
J0881 DARBEPOETIN ALFA, NON-ESRD
J0885 EPOETIN ALFA, NON-ESRD
J0886 EPOETIN ALFA 1000 UNITS ESRD
J0894 DECITABINE INJECTION
J1040 METHYLPREDNISOLONE 80 MG INJ
J1050 MEDROXYPROGESTERONE INJ
J1100 DEXAMETHASONE SODIUM PHOS
J1170 HYDROMORPHONE INJECTION
J1260 DOLASETRON MESYLATE
J1561 IMMUNE GLOBULIN 500 MG
J1566 IMMUNE GLOBULIN, POWDER
J1626 GRANISETRON HCL INJECTION
J1631 HALOPERIDOL DECANOATE INJ
J1745 INFLIXIMAB INJECTION
J1885 KETOROLAC TROMETHAMINE INJ
J2357 OMALIZUMAB INJECTION
J2405 ONDANSETRON HCL INJECTION
MHTPS_HCPCS_NDC_021014 Updated as of 1/30/1425
Procedure Code HCPCS Description
J2430 PAMIDRONATE DISODIUM /30 MG
J2469 PALONOSETRON HCL
J2505 INJECTION, PEGFILGRASTIM 6MG
J2550 PROMETHAZINE HCL INJECTION
J2794 RISPERIDONE, LONG ACTING
J2820 SARGRAMOSTIM INJECTION
J3010 FENTANYL CITRATE INJECITON
J3370 VANCOMYCIN HCL INJECITON
J3487 ZOLEDRONIC ACID
J3490 DRUGS UNCLASSIFIED INJECTION
J7050 NORMAL SALINE SOLUTION INFUS
J7178 HUMAN FIBRINOGEN CONC INJ
J7180PRESCRIPTION, LEGEND, DRUG, FOR MENTAL OR NERVOUS CONDITIONNew description: INJECTION, FACTOR XIII (ANTIHEMOPHILIC FACTOR, HUMAN), 1 I.U.
J7183 WILATE INJECTION
J7185 XYNTHA INJ
J7186 Antihemophilic viii/vwf comp
J7187 HUMATE-P, INJ
J7189 FACTOR VIIA
J7190 FACTOR VIII
J7192 FACTOR VIII RECOMBINANT
J7193 FACTOR IX NON-RECOMBINANT
J7194 FACTOR IX COMPLEX
J7195 FACTOR IX (ANTIHEMOPHILIC FACTOR, RECOMBINANT) PER I.U.
MHTPS_HCPCS_NDC_021014 Updated as of 1/30/1426
Procedure Code HCPCS Description
J7197 ANTITHROMBIN III INJECTION
J7198 ANTI-INHIBITOR
J7300 INTRAUT COPPER CONTRACEPTIVE
J7302 LEVONORGESTREL IU CONTRACEPT
J7303 CONTRACEPTIVE VAGINAL RING
J7304 CONTRACEPTIVE HORMONE PATCH
J7307 ETONOGESTREL IMPLANT SYSTEM
J7644 IPRATROPIUM BROM INH SOL U D
J9000 DOXORUBIC HCL 10 MG VL CHEMO
J9025 AZACITIDINE INJECTION
J9035 BEVACIZUMAB INJECTION
J9040 BLEOMYCIN SULFATE INJECTION
J9041 BORTEZOMIB INJECTION
J9045 CARBOPLATIN INJECTION
J9055 CETUXIMAB INJECTION
J9060 CISPLATIN 10 MG INJECITON
J9178 INJ, EPIRUBICIN HCL, 2 MG
J9190 FLUOROURACIL INJECTION
J9201 GEMCITABINE HCL
J9206 IRINOTECAN INJECTION
J9217 LEUPROLIDE ACETATE SUSPNSION
J9263 OXALIPLATIN
J9264 PACLITAXEL PROTEIN BOUND